Fetal deaths in Brazil: What changed in the last decade and what can we learn from the current situation?

Abstract

To determine fetal death rates (FDRs) according to maternal characteristics in Brazil. A serial cross-sectional analysis was conducted based on vital statistics of the Brazilian population from 2007 to 2019. FDRs were estimated according to maternal and pregnancy characteristics. Annual percent change (APC) of FDR was assessed by joinpoint regression model. Causes of death were compared between the ante-/intrapartum periods. A significant reduction in FDR occurred in Brazil during 2007-2019 (11.1 and 10.43 in 2007 and 2019, respectively; APC -0.44). Only the northern region showed an increase in FDR. In 2019, the northeast and southeast had the highest and lowest FDRs, respectively (11.4 and 7.8/1000 live births). In adolescents, FDR increased from 2007 to 2016 (APC 1.75). In 2019, missing information was significantly high for maternal skin color (99.7%), schooling (17.0%), and age (7.0%) in fetal death registries. The most common causes of fetal death in the ante-/intrapartum periods were fetus and newborn affected by maternal conditions. A reduction in FDR has been achieved in Brazil over the last decade. However, there is an unmet need for decreasing social and regional disparities. A better system to attribute causes of death is needed to identifying priorities in maternal-fetal health care.